Splenic Hemangioma?

Two years ago a 2 cm lesion was discovered on my spleen during a CT scan for something else.  A repeat scan 3 months later showed not change.  Two other follow up sonograms were done and the lesion remained stable and was diagnosed as a probable hemangioma.  Another sonogram done at 2 years showed that the lesion had enlarged from 2 cm to 2.4 cm, but it was still considered benign.

After the first year of follow up, the radiologist indicated that no further scans were needed.  Now that the lesion is larger, he made no recommendation.  I have been unable to determine if it is normal for such lesions to enlarge, and if an enlargement after 2 years suggests that it will keep enlarging or that it isn't a hemangioma.  The hematologist oncologist I saw said that the lesion could be stable for years and still be cancer but that she did not really know much about spleens.

Sometimes the area of my spleen seems a little sore, but my doctor has told me to call her if I have any abdominal pain.  Not sure that the real indications that I need medical attention would be.  The only other problem I have had that pertained to red blood cells was that I had an undiagnosed vitamin B 12 deficiency for over 10 years (I'm vegan,) that enlarged my red blood cells to 105 or so; now they are 91.

[Enoch Choi, MD]

As doctors use ultrasound and imaging procedures more, they are finding splenic calcification and cysts more often, and almost always have nothing to do with any specific symptoms.  You haven't described the lesion, so I'll mention 2 kinds of lesions that can be diagnosed as "probable hemangioma":

Calcification can occur from phleboliths, splenic artery aneurysm, sickle cell disease, tumors (eg, hemangioma, hemangiosarcoma, lymphoma), and infections (eg, histoplasmosis, brucellosis, echinococcosis, candidiasis, tuberculosis) and other causes.  

A splenic cyst (or cysts) can result from:
Post-traumatic cysts/pseudocysts, including cystic splenosis
Hydatid (echinococcal) cysts
Congenital cysts
Epidermoid, mesothelial cysts
Hemangioma, lymphangioma
Polycystic kidney disease with splenic cysts
Splenic peliosis
Cystic metastasis to the spleen
They can stay the same size or may enlarge slowly, then rupture, bleed, or become infected. There is not a "best practice" or optimal surgical management for these lesions.

With pain or for cysts that are enlarging over time, imaging and surgical procedures can help diagnose what's there. If it's not from a parasite, an interventional radiologist can perform percutaneous procedures (eg, biopsy, aspiration, drainage), or a surgeon can consider decapsulation/cyst wall unroofing, partial or total splenectomy.

These are options you can discuss with your doctor to consider how to follow your lesion.  Good luck!

Enoch Choi, MD